Journal List > J Breast Cancer > v.9(2) > 1036774

Hwang, Moon, Cho, Han, Kim, Shin, Hwang, Lee, Youn, Oh, and Noh: Preoperative Evaluation of Lymph Node Metastasis with Using Ultrasonography for Examining the Axilla in Early Stage Breast Cancer

Abstract

Purpose

he axillary lymph node status is the most significant prognostic factor in breast cancer. The development of tools to accurately evaluate the axillary lymph node status with less morbidity has been the important treatment issue. Although sentinel lymph node biopsy is the promising alternative to axillary lymph node dissection, the high false negative rate of this procedure is a considerable problem. This study aimed to evaluate the efficacy of performing preoperative axillary ultrasonography (US) for predicting axillary lymph node metastasis.

Methods

Between January 2003 and December 2004, preoperative axillary US was performed in 646 patients who were suffering with T1 or T2 infiltrating ductal carcinoma and they had no palpable axillary lymph nodes.

Results

The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of preoperative axillary US findings were 82.8%, 93.2%, 86.3%, 91.2%, and 89.6%, respectively. The positive and negative predictive values for performing axillary US findings for tumors with a size ≤2cm were 76.2% and 92.5%, respectively. For tumors with a size >2cm, the positive and negative predictive values were 90.6 and 89.4, respectively.

Conclusion

We found that performing preoperative axillary US is a relatively accurate and useful non-invasive method for assessing axillary lymph node metastasis. It showed the potential to replace sentinel lymph node biopsy in tumors ≤2cm in size with low false negative rate. If we can improve the positive predictive value of US finding by using strict decision criteria, and especially for the tumors >2cm in size, then axillary lymph node dissection might be recommended for the cases with positive US finding.

References

1. Fisher B, Bauer M, Wickerham DL. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer. 1983. 52:1551–1557.
crossref
2. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003. 349:546–553.
crossref
3. Giuliano AE, Haigh PI, Brennan MB, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol. 2000. 18:2553–2559.
crossref
4. Noguchi M. Sentinel lymph node biopsy and breast cancer. Br J Surg. 2002. 89:21–34.
crossref
5. Vijayakumar V, Boerner PS, Jani AB, Vijayakumar S. A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer. Nucl Med Commun. 2005. 26:395–405.
crossref
6. Kelley MC, Hansen N, Mc Masters KM. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Am J Surg. 2004. 188:49–61.
crossref
7. Bruneton JN, Caramella E, Hery M, Aubanel D, Manzino JJ, Picard JL. Axillary lymph node metastases in breast cancer: preoperative detection with US. Radiology. 1986. 158:325–326.
crossref
8. de Freitas R, Costa MV, Schneider SV, Nicolau MA, Marussi E. Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastases in breast cancer. Eur J Surg Oncol. 1991. 17:240. 240.
9. Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med. 1996. 15:241–246.
crossref
10. Nationwide Korean Breast Cancer Data of 2004. The Korean Breast Cancer Society.
11. Lee CS, Bong JG, Park JH, Lee YS, Paik SM, Shin MJ, et al. The accuracy of the physical examination, mammography, and ultrasonography in the assessment of tumor size and axillary lymph node metastasis in breast cancer patient. J Korean Breast Cancer Soc. 2003. 6:87–94.
crossref
12. Rajesh YS, Ellenbogen S, Banerjee B. Preoperative axillary ultrasound scan: its accuracy in assessing the axillary nodal status in carcinoma breast. Breast. 2002. 11:49–45.
crossref
13. Sato K, Tamaki K, Tsuda H, Kosuda S, Kusano S, Hiraide H, et al. Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy. Am J Surg. 2004. 187:679–683.
crossref
14. Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer. 1992. 66:136–138.
crossref
15. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Surg. 1986. 73:580–584.
crossref
16. Shaw JH, Rumball EM. Complications and local recurrence following lymphadenectomy. Br J Surg. 1990. 77:760–764.
crossref
17. Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection: a randomized prospective study. Ann Surg. 1981. 193:288–295.
18. de Kanter AY, van Eijck CH, van Geel AN, Kruijt RH, Henzen SC, Paul MA, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with Breast cancer. Br J Surg. 1999. 86:1459–1462.
crossref
19. Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, et al. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer. 2003. 88:702–706.
crossref
20. Deurloo EE, Tanis PJ, Gilhuijs KGA, Muller SH, Kröger R, Peterse JL, et al. Reduction in the number of sentinel lymph node Procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer. 2003. 39:1068–1073.
crossref
21. Podkrajsek M, Music MM, Kadivec M, Zgajnar J, Besic N, Pogacnik A, et al. Role of ultrasound in the preoperative staging of patients with breast cancer. Eur Radiol. 2005. 15:1044–1050.
crossref
22. Yang WT, Chang J, Metreweli C. differences in color flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology. 2000. 215:568–573.
crossref
23. Esen G, Gurses B, Yilmaz MH, Ilvan S, Ulus S, Celik V, et al. Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol. 2005. 15:1215–1223.
crossref
24. Lernevall A. Imaging of axillary lymph nodes. Acta Oncol. 2000. 39:277–281.
crossref
TOOLS
Similar articles